"It is the Core of Our Oath:" Why Gender-Affirming Care Is a Fundamental Pharmacy Mandate

For many individuals, the community pharmacy is the most accessible health care resource available, requiring no appointments and sitting right in the heart of the neighborhood. Yet, for the LGBTQ+ community, this accessibility is often overshadowed by systemic barriers, ranging from rigid insurance formularies and medication shortages to the fear of being "deadnamed" at the register.

At Southern Star Pharmacy, Sean Gatz, PharmD, the director of pharmacy, is transforming these daily operations into a mission of advocacy and dignity.

“Early in my pharmacy journey, like many clinicians, my training was heavily anchored in the clinical mechanics like the exact pharmacokinetics of hormone replacement therapies, titration schedules, drug interactions, and strict laboratory monitoring, but as I stepped into leadership, my entire perspective shifted,” Gatz said. “I realized that the intersection of pharmacy and gender-affirming care isn't just clinical. It is profoundly human and deeply operational.”

Gatz shares how his perspective has evolved from a focus on clinical mechanics—such as hormone titration and pharmacokinetics—to a human and deeply operational leadership style. He argues that being gender-affirming is more than a baseline of stocking medication, and it requires intentionally designing systems—from pharmacy management software to private counseling spaces—that shield vulnerable patients from anxiety and validate their identities.

Gatz also addresses the operational tenacity required to navigate today’s complex health care climate. Whether fighting insurance rejections or providing proactive outreach during legislative shifts, he views his role as a "steady, calm anchor" for patients in the middle of legal and administrative storms.

By prioritizing radical humility and consistency, Gatz and his team work to dismantle walls of medical trauma, ensuring that every visit is safe, predictable, and respectful. Looking toward the future, Gatz finds hope in a new generation of pharmacy professionals who view inclusive care not as a specialized initiative but as a fundamental, non-negotiable standard of practice.

Drug Topics®: Can you describe how your role as a community pharmacist intersects with gender-affirming care and how that's evolved over time?

Sean Gatz, PharmD: Early in my pharmacy journey, like many clinicians, my training was heavily anchored in the clinical mechanics like the exact pharmacokinetics of hormone replacement therapies, titration schedules, drug interactions, and strict laboratory monitoring, but as I stepped into leadership, my entire perspective shifted. I realized that the intersection of pharmacy and gender-affirming care isn't just clinical. It is profoundly human and deeply operational.

Over time, I’ve watched the health care landscape become increasingly difficult for LGBTQ+ individuals to navigate. Community pharmacists are often the most accessible health care providers a person sees—there are no appointments required, and we are right there in the neighborhood. Because of that, my role has evolved from simply overseeing the safe dispensing of a medication to actively defending a patient’s dignity. It has changed how I view my responsibility as an administrator.

It’s no longer just about moving a prescription through a workflow safely. It is about intentionally designing that workflow so that every single touchpoint shields a vulnerable patient from anxiety and validates who they are.

Drug Topics: What does it mean for a pharmacy to be gender-affirming beyond just stocking the right medications?

Gatz: Stocking medication is just the baseline of pharmacy operations. Being truly gender-affirming lives in the nuances of your culture and your systems. It means configuring your pharmacy management software so that a patient’s chosen name and pronouns are prominently displayed to prevent deadnaming at the register. It means designing private counseling spaces where patients don't feel exposed. It means auditing your administrative processes to ensure that a legal name required by insurance doesn't override the human being standing in front of you. A pharmacy becomes gender-affirming when its daily operations are intentionally built to reduce patient anxiety and reinforce their identity.

Drug Topics: How do you approach building trust with patients who may have had negative health care experiences in the past?

When a patient walks in with defensive walls up because of past medical trauma, you cannot expect trust overnight but to gain inches. I approach these interactions with baby steps and radical humility. I start by listening without interrupting, validating their concerns, and letting them take the lead in describing their health goals. If we make a mistake—like an accidental misgendering by a new staff member—we don't get defensive. We apologize sincerely, correct it immediately in our system, and ensure it doesn't happen again. Consistency builds trust. When a vulnerable patient realizes that every single visit to your pharmacy will be safe, predictable, and respectful, those walls naturally begin to come down.

Drug Topics: What counseling points do you prioritize when a patient picks up hormone therapy for the first time?

Gatz: For a first-time pickup, my priority is balancing thorough clinical education with emotional reassurance. This is a monumental day for the patient, so I want them to feel supported, not overwhelmed. Beyond the standard injection techniques, storage, and lab work monitoring schedules, I focus heavily on setting realistic expectations regarding the timeline of physical changes. I talk openly about potential [adverse] effects—not to scare them but to empower them. Most importantly, I prioritize counseling on adherence and safety, ensuring they know exactly what to expect starting treatment and who to call if they feel discouraged or experience unexpected changes. I want them to leave the consultation window knowing what to expect as outlined below:

• For transgender women (MTF) the goals of medication therapy include:
  • Feminization begins in the first 3 to 6 months of therapy and reaches peak effect on average at 3 years
  • Elimination of facial hair growth
  • Induction of breast formation
  • Decrease in muscle mass and redistribution of fatty tissue
• For transgender men (FTM) the goals of therapy include:
  • Masculinization begins around 1 month & reaches max effect ~5 years
  • Stopping menses
  • Stimulation of body and facial hair growth
  • Deepening of the voice
  • Increasing muscle mass
  • Reducing breast tissue

Drug Topics: What are the most common access barriers your patients face when trying to obtain gender-affirming medications?

Gatz: The barriers our patients face are frequent, frustrating, and deeply systemic. On any given day, we are fighting rigid insurance formularies, convoluted prior authorization (PA) criteria, steep out-of-pocket costs, and the ongoing, exhausting supply chain disruptions and manufacturer shortages of critical drug formulations. It is incredibly heartbreaking to look at a patient and know that their life-altering, life-saving care is being stalled by administrative red tape or a backordered vial.

As a manager, this is where operational tenacity becomes a form of patient advocacy. My teams do not just accept an insurance rejection code, click “close,” and move on to the next task. I empower my team to roll up their sleeves. We actively track down PAs, coordinate directly with providers to switch to alternative formulations or delivery methods when shortages hit, and exhaustively audit copay cards and patient assistance programs to bring costs down to zero if possible. Advocacy in community pharmacy means fighting the friction behind the scenes so that when the patient arrives at the window, the answer is “Yes, we have it ready for you.”

Drug Topics: In states where legislation has created new restrictions on gender-affirming care, how can a practice adapt and support affected patients?

Navigating rapidly shifting state regulations and legislative environments is one of the most complex challenges a modern pharmacy leader can face. However, as clinicians and administrators, our twin mandates must remain unshakeable: maintaining strict legal integrity and preserving patient safety. To adapt effectively in a turbulent climate, you cannot be reactive. You must stay completely ahead of the curve by meticulously reviewing board of pharmacy updates, statutory changes, and legal boundaries so your practice knows exactly what is permitted.

But true support goes beyond legal compliance—it lives in how you communicate. Shifting laws create immense fear, confusion, and anxiety for patients. We make it a point never to let a patient find out about a care disruption at the cash register. We practice proactive outreach. If a regulatory shift impacts a therapy plan, we reach out immediately with empathy, explain the situation transparently, and work hand-in-hand with their providers to explore every lawful pathway, continuity-of-care protocol, or alternative resource available. Our job as pharmacy leaders is to be the steady, calm anchor in the middle of a legal storm, ensuring our patients never feel abandoned by their healthcare team.

Drug Topics: How do you train your entire pharmacy team—technicians, interns, and front-of-house staff—to interact respectfully and knowledgeably with LGBTQ+ patients?

Gatz: Cultural competence and respectful care cannot be achieved through an annual, check-the-box training module or a memo taped to the wall. It must be woven into the daily DNA and operational culture of the pharmacy. As a leader, I believe in practical, hands-on staff development. We train our entire team on the operational “why” behind our protocols.

We actively run through real-world scenarios, [such as] how to navigate insurance profiles where a legal name must be used for billing but ensuring the patient’s chosen name and pronouns are prominently flagged in our pharmacy management software so they are never deadnamed at the register. We train staff on how to use inclusive language naturally and how to handle an accidental mistake with immediate, sincere correction rather than defensiveness. I teach my team that a slip-up at the consultation window or register isn't just a minor clerical error—it directly impacts a human being's mental well-being and their trust in health care. When you set a high standard of accountability and couple it with genuine empathy, the entire team rises to meet it because they understand the profound impact of their respect.

Drug Topics: What's your message to community pharmacists who want to be more supportive but don't know where to start?

Gatz: Don't let the fear of saying the wrong thing paralyze you from doing the right thing. Start small. Educate yourself using incredible resources from professional organizations. Look at your pharmacy through the eyes of a patient: Do your intake forms have a space for chosen names? Does your team know basic LGBTQ+ health disparities? Being an ally in pharmacy doesn't require you to be an immediate expert in every clinical nuance. It requires a willingness to listen, learn, and show up with an open heart. Your patients will recognize and appreciate the genuine effort.

Drug Topics: Looking ahead, what gives you hope about the direction of gender-affirming care in community pharmacy?

Gatz: What gives me the absolute greatest amount of hope is the incredible caliber of the next generation of pharmacy and medical professionals—the student interns, residents, and young professionals who are stepping into our clinics and pharmacies right now. When I entered the profession, clinical curriculums were almost exclusively focused on the hard science of pharmacology and rigid, standardized disease-state management. Cultural humility and social determinants of health were often treated as secondary, optional concepts.

Today, the script has completely flipped. The young professionals coming through our doors aren't just brilliant clinicians. They arrive with an innate, deeply ingrained understanding of patient advocacy and systemic health disparities. They don’t see inclusive care as a specialized initiative or an administrative burden—they see it as a fundamental, non-negotiable standard of practice. They expect their pharmacy software, their standard operating procedures, and their leadership to mirror that inclusivity.

Watching them interact with patients with such natural grace, courage, and respect makes it clear where our profession is heading. We are steadily moving away from a landscape where finding a safe, gender-affirming community pharmacy feels like a rare stroke of luck for a patient. Instead, because of this rising generation's passion and empathy, comprehensive and dignified care is becoming the baseline standard across the entire healthcare continuum. The future of pharmacy is incredibly bright, and it is firmly in the hands of people who lead with their hearts.

Drug Topics: Is there anything else you would like to add?

Gatz: At the end of the day, pharmacy leadership isn’t just about managing workflows, drug spend, or inventory metrics. It’s about people. Every prescription we fill represents a life, a family, and a story. Providing gender-affirming care with dignity and heart isn't extra work—it is the core of our oath as pharmacists. When we use our leadership platforms to protect and care for the most vulnerable among us, we elevate the entire profession of pharmacy and fulfill the oath to professionalism taken during our white coat ceremonies.